Articles: back-pain.
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Orthopaedic nursing · Jan 1992
ReviewPerception of control and appraisal of illness in chronic low back pain.
People who experience chronic low back pain face significant changes in their lives, and it is unclear why some people adapt to the pain situation better than others. Using a cognitive appraisal model, outcomes of the pain situation were examined in 40 chronic low back pain patients using situational control and appraisal of illness as predicted mediating factors. This article presents background of the problem and the results of the study.
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A consecutive series of 98 patients presenting at an orthopedic outpatient clinic with chronic low back pain of at least 6 months' duration and with no organic findings (ruled out by clinical and radiological examination) were evaluated by means of a questionnaire which included the constructs "patient history," "pain-related restrictions," and "depression." Pain perception was evaluated with an adjective list revealing four main factors: two affective factors, i.e., "suffering from pain" and "anxiety," and two sensory factors, i.e., "acuteness" and "rhythmics of pain." The two affective factors (as against the sensory factors) subsequently influence the degree of pain intensity (measured with a visual analog scale), the patient's history and the patient's perceived impairment of daily life. Depression (von Zerssen scale) correlated with pain factors only when the whole range of pain factors was considered. The implications for treatment in patients with a high score for affective factors in the adjective list (indicator for a low success rate with traditional therapy) are discussed.
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This study examined factors that help to identify low back pain patients who do not benefit from a lumbar epidural steroid injection (LESI). Two-hundred and forty-nine chronic low back pain patients assessed their pain intensity before, 1 day after, and 2 weeks after receiving a LESI. All patients completed a comprehensive pain questionnaire and a Brief Symptom Inventory (BSI) prior to treatment. ⋯ Nine patients (7%) felt that the treatment was harmful. Four factors were identified that best predicted poor outcome 2 weeks after LESI: (a) greater number of previous treatments for pain; (b) more medications taken; (c) pain not necessarily increased by activities, and (d) pain increased by coughing. Factors that predicted no benefit 1 year after treatment included (a) pain does not interfere with activities; (b) unemployment due to pain; (c) normal straight-leg raise test prior to treatment; and (d) pain not decreased by medication.
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Relationships between locus of control beliefs (HLC), psychological distress (GHQ-12), and coping strategies were studied in 415 subjects with low back pain (LBP) (2 of 3 were men, with a mean age of 45 years). Those with more external beliefs and symptoms of psychological distress reported more severe LBP. ⋯ Irrespective of the degree of LBP, use of more active behavioral coping strategies were more frequent in subjects who had strong beliefs in internal control over back pain. In addition, catastrophizing thoughts were more frequent in subjects who had symptoms of psychological distress.